Over the last few months, the Alliance and its members have engaged with the NAO to provide evidence on how NHS England has implemented its specialised commissioning responsibilities to date.

The NAO’s main findings are that:

1. While national commissioning has strengthened NHS England’s position to influence providers, it is not clear that commissioning hubs have the skills to manage contracts effectively
2. The scale of specialised commissioning was underestimated by NHS England and financial problems have persisted, caused by a combination of incorrect baseline budgets, poor contracting and new medicines costs
3. There are concerns on the governance established for specialised commissioning, including the delineation of oversight groups and operational control, as well as criticism of NHS England’s failure to be more transparent
4. NHS England does not have the information it needs to drive service improvements in specialised services, nor does it have the data to assess whether patient outcomes or inequalities are changing
5. “Until NHS England significantly improves its strategic and operational arrangements for the commissioning of specialised services [the NAO] cannot conclude that the current commissioning arrangements are providing value for money.”

The Alliance now calls on NHS England to act rapidly on the areas the NAO has highlighted for improvement, including the clarity and transparency of its decision-making procedures, the competency of its contracting, and its use of data and information to improve patient outcomes.